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Necessary measures to mitigate the impact of the pandemic Given the current epidemiology and risk assessment, and the expected developments in the next days to few weeks, the following public health measures to mitigate the impact of the pandemic are necessary in EU/EEA countries:Social distancing measures should be implemented early in order to mitigate the impact of the epidemic and to delay the epidemic peak. This can interrupt human-to-human transmission chains, prevent further spread, reduce the intensity of the epidemic and slow down the increase in cases, while allowing healthcare systems to prepare and cope with an increased influx of patients. Such measures should include:the immediate isolation of symptomatic persons suspected or confirmed to be infected with COVID-19;the suspension of mass gatherings, taking into consideration the size of the event, the density of participants and if the event is in a confined indoor environment;social distancing measures at workplaces (for example teleworking, suspension of meetings, cancellation of non-essential travel);measures in and closure of schools, taking into consideration the uncertainty in the evidence of children in transmitting the disease, need for day care for children, impact on nursing staff, potential to increase transmission to vulnerable grandparents;cordon sanitaire of residential areas with high levels of community transmission.Ensuring the public is aware of the seriousness of COVID-19. A high degree of population understanding, solidarity and discipline is required to apply strict personal hygiene, coughing etiquette, self-monitoring and social distancing measures. Community engagement and acceptance of stringent social distancing measures put in place are key in delaying and reducing further spread.Prevention and control of COVID-19 in hospitals and long-term care facilities is an immediate priority in order to: (1) slow the demand for specialised healthcare, such as ICU beds; (2) safeguard populations vulnerable to severe outcomes of infection (3); protect healthcare workers that provide care; (4) minimise the export of cases to other healthcare facilities and the community.Every healthcare facility should initiate training for all staff and those who may be required for healthcare provision during surge capacity. Countries should identify healthcare units that can be designated to care for COVID-19 cases, to minimise transmission to non-cases and to conserve PPE. Countries and healthcare institutions should identify additional facilities that can be used for the cohorting of cases with mild symptoms, in the event that surge capacity is exceeded by healthcare facilities. The highest priority for use of respirators (FFP2/3) are healthcare workers, in particular those performing aerosol-generating procedures, including swabbing.If resources or capacity are limited, rational approaches should be implemented to prioritise high-yield actions, which include: rational use of confirmatory testing, reducing contact tracing to focus only on high-yield contacts, rational use of PPE and hospitalisation and implementing rational criteria for de-isolation. Testing approaches should prioritise vulnerable populations, protection of social and healthcare institutions, including staff.National surveillance systems should initially aim at rapidly detecting cases and assessing community transmission. As the epidemic progresses, surveillance should monitor the intensity, geographical and the impact of the epidemic on the population and healthcare systems and assess the effectiveness of measures in place. In circumstances with capacity shortages and strict implementation of social distancing measures, surveillance should focus on severe acute respiratory infections, sentinel surveillance in outpatient clinics or collection of data through telephone helplines. A strategic approach based on early and rigorous application of these measures will help reduce the burden and pressure on the healthcare system, and in particular on hospitals, and will allow more time for the testing of therapeutics and vaccine development. oronavirus: hospitals must learn from past pandemics Use techniques honed during the SARS, H1N1 and Ebola epidemics to separate sick and well, keep workers safe and prepare for the next outbreak, says Nahid Bhadelia Nahid Bhadelia PDF versionThe world that is grappling with 2019 novel coronavirus (2019-nCoV) is different from how it was during the SARS and H1N1 pandemics. The disease itself, and information and disinformation, now travel faster than ever. I worked as a clinician in West Africa during the Ebola outbreak, and in New York City hospitals during the H1N1 one. Now, I’m working in Boston, Massachusetts, to prepare for potential cases of 2019-nCoV acute respiratory disease. And many of the challenges are the same as those faced in previous outbreaks. The specifics of each virus are important, but so is an overarching question: what do you do when large numbers of people arrive wanting care for suspected infections of an unfamiliar disease? This comes down to three decisions: how to quickly identify infected people, how to isolate and care for them and how to keep health-care workers safe.
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